{% extends "templates/base.html" %}
{% block head %} {{ super() }}{% endblock %}
{% block header %}
{{ page_title(id="registration", title="OYPAA 2013 Online Registration") }}
	{% block content %}
		<div class="well well-large span10 offset2">
	       	<div class="offset1 row">
	       		<h3>Confirm your Information</h3>
	       		<h6>Please select "Back" if you need to change your information</h6>
	       		<div class="offset1">
		       		<table>
		       			<tbody>
		       				<tr>
		       					<td>First Name: </td>
		       					<td><span class="uneditable-input">{{user.first_name}}</span></td>
		       				</tr>
		       				<tr>
		       					<td>Last Name: </td>
		       					<td><span class="uneditable-input">{{user.last_name}}</span></td>
		       				</tr>
		       				<tr>
		       					<td>Street Address: </td>
		       					<td><span class="uneditable-input">{{user.street_address}}</span></td>
		       				</tr>
		       				<tr>
		       					<td>City: </td>
		       					<td><span class="uneditable-input">{{user.city}}</span></td>
		       				</tr>
		       				<tr>
		       					<td>State: </td>
		       					<td><span class="uneditable-input">{{user.state}}</span></td>
		       				</tr>
		       				<tr>
		       					<td>Zip Code: </td>
		       					<td><span class="uneditable-input">{{user.zip_code}}</span></td>
		       				</tr>
		       				<tr>
		       					<td>Email: </td>
		       					<td><span class="uneditable-input">{{user.email}}</span></td>
		       				</tr>
		       				<tr>
		       					<td>Phone Number: </td>
		       					<td><span class="uneditable-input">{{user.phone_number}}</span></td>
		       				</tr>
		       			</tbody>
		       		</table>
	       		</div>
	       	</div>
	       	<div class="offset1 row">
	       		<h3> Pay with Paypal </h3>
	       		<h6> Select the Checkout with Paypal Button below to Pay $10.00 for Registration</h6>
				<form method=post action="{{ settings.PAYPAL_PAYMENT_HOST }}{{ token }}"> 
					<div class="registration_form" style="text-align:center;" data-role="fieldcontain">
						<input type="hidden" name="first_name" value="{{user.first_name}}">				
						<input type="hidden" name="last_name" value="{{user.last_name}}">
						<input type="hidden" name="street_address" value="{{user.street_address}}">
						<input type="hidden" name="city" value="{{user.city}}">
						<input type="hidden" name="state" value="{{user.state}}">				
						<input type="hidden" name="zip_code" value="{{user.zip_code}}">
						<input type="hidden" name="email" value="{{user.email}}">
						<input type="hidden" name="phone_number" value="{{user.phone_number}}">
						<input type="hidden" name="business" value="sales@cannonfuse.com">			
						<input type="hidden" name="redirect_cmd" value="_xclick">					
						<input type="hidden" name="currency_code" value="USD">					
						<input type="hidden" name="invoice" value="80646">
						<input type="hidden" name="custom" value="">					
						<input type="hidden" name="notify_url" value="{{settings.HOST}}/ipn">
						<input type="hidden" name="return" value="{{settings.HOST}}/return">					
						<input type="hidden" name="cancel_return" value="{{settings.HOST}}/cancel">
					</div>
					<div class="offset2" data-type="horizontal" data-role="controlgroup">
						<button type=submit name="submit" value="Checkout at Paypal.com">
						<img src="https://www.paypalobjects.com/en_US/i/btn/btn_xpressCheckout.gif" align="center">
						</button>
					</div>
				</form>
			</div>
		</div>
	{% endblock %}
{% endblock %}